Intended for healthcare professionals

Information In Practice

Why general practitioners use computers and hospital doctors do not—Part 2: scalability

BMJ 2002; 325 doi: (Published 09 November 2002) Cite this as: BMJ 2002;325:1090
  1. Tim Benson, managing consultant (
  1. Abies Ltd, 24 Carlingford Road, London NW3 1RX

    The actions of the medical profession and the British government have encouraged general practitioners to embrace computing at the same time that hospital doctors were alienated. However, clinical computing for a general practice is technically much easier than for a whole hospital or health district. This review focuses on technical issues (patient record architecture, terminology, interoperability standards, security, and developments in computer technology) which prevent what works for general practice working well in hospitals. These issues, which are all related to scalability, present a major challenge to those responsible for delivering the new vision of integrated 21st century information technology support for the NHS.1

    Summary points

    General practice computerisation has been a success, but what works in a GP surgery does not readily scale up to work in a hospital

    Computer based patient records have a more diverse range of uses in hospitals than in general practice, and simple unidimensional classification schemes such as the original Read codes cannot cope

    In hospitals many different computer systems need to be linked together, requiring common interoperability standards

    Protection of privacy is a much greater problem in hospitals

    The number of potential users in hospitals makes substantial demands on hardware and networks


    This article has had a long gestation. Much of the evidence comes from my experience over nearly 30 years, first as leader of the computer evaluation unit at the Charing Cross Hospital, London (1974-80), then as a general practice system supplier (1980-90), and as a supplier of clinical information systems for hospital doctors (1990-9). An initial version of the article was written in 1993 and extended for the NHS Executive's integrated clinical workstation project 1995. A later version was presented at the AMIA Symposium, Washington, DC, November 2001 (proceedings, pp 42–46).

    Patient records architecture

    Computer based patient records have long been seen …

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